Provider Demographics
NPI:1639100720
Name:GREATER MILWAUKEE MEDICAL SERVICES
Entity Type:Organization
Organization Name:GREATER MILWAUKEE MEDICAL SERVICES
Other - Org Name:M.R. SETHI, MD SC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CJ
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-444-6000
Mailing Address - Street 1:PO BOX 11943
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-0943
Mailing Address - Country:US
Mailing Address - Phone:414-444-6000
Mailing Address - Fax:888-664-5360
Practice Address - Street 1:7620 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-5002
Practice Address - Country:US
Practice Address - Phone:414-444-6000
Practice Address - Fax:888-664-5360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI04-03601OtherUNITED HEALTHCARE
WI21309300Medicaid
WI4064161OtherAETNA
WI184893491542OtherHUMANA
WI109500484OtherWPS
WI21309300Medicaid
WI109500484OtherWPS